Microbioz India : November 2019 edition by Microbioz India,Laboratory Equipment,Magazines,Pharma and Healthcare News,Laboratory News

10 Cover Story

Dear friends and readers, I hope you would have enjoyed reading our previous issue. Once again, I am delighted to bring to you the November 2019 edition of the Microbioz India Health edition, supported by the cover story entitled “The Looming Threat of Reused Insulin needles, Word of Caution for People living with diabetes”. The article features Diabetes and how reuse of needles is very dangerous to a patient.

Featured article

Added to this, the current edition has a special featured guest article entitled “Diabetic Retinopathy” an article by Dr. Rajesh R, Consultant Vitreo-retina & Ocular Oncology, Sankara Eye Hospital. The article informs about Diabetic retinopathy which is usually starts as a mild disease. During the initial stages, the blood vessels in the retina become weak and small bulges are developed called microaneurysms.

Product Launches

The edition also covers recent Healthcare news articles and product launches collected from worldwide sources to update the readers with the current trends in the industry

Young children and adults above 65 years of age are most prone to pneumonia

Pneumonia is referred to as the infection that inflames the air sacs (alveoli) in either one or both the lungs.

New Test for Thyroid Cancer Could Prevent Unnecessary Surgery

Researchers at the University of Texas at Austin and Baylor College of Medicine have developed a new preoperative test for thyroid cancer that is faster and about two-thirds more accurate than the diagnostics physicians use today.

High-Efficiency Laminar-Flow Hoods Purair laminar-flow hoods from Air Science, Fort Myers, Fla, are high-efficiency products designed to protect equipment and other contents of the work zone from particulates.

Microbioz India, October 2019

ear friends and readers, I hope you would have enjoyed reading our previous issue. Once again, I am delighted to bring to you the November 2019 edition of the Microbioz India Health edition, supported by the cover story entitled “The Looming Threat of Reused Insulin needles, Word of Caution for People living with diabetes”. The article features Diabetes and how reuse of needles is very dangerous to a patient. Insulin therapy is often a crucial part of diabetes management. About 35 percent of people living with diabetes are currently on insulin. In people with type 1 diabetes insulin is the mainstay of treatment. However, people with type 2 who are not well controlled on oral drug therapy, diet and exercise may also need insulin injections to control the blood glucose levels and prevent long-term complications from the disease like cardiovascular disease, stroke, peripheral vascular disease, kidney disease etc. These risks can be significantly reduced through good glycaemic control, diet, exercise and taking insulin properly. Added to this, the current edition has a special featured guest article entitled “Diabetic Retinopathy” an article by Dr. Rajesh R, Consultant Vitreo-retina & Ocular Oncology, Sankara Eye Hospital. The article informs about Diabetic retinopathy which is usually starts as a mild disease. During the initial stages, the blood vessels in the retina become weak and small bulges are developed called microaneurysms. These may burst causing tiny blood hemorrhages on the retina. Normally they do not cause symptoms affecting the vision. Diabetics don't develop diabetic retinopathy if the disease is less than 10 years however, it is better not to delay an eye test. We have the latest market research news and insightful product launches inside, collected from worldwide sources to keep you updated with what is going on in the industry. Dear friends and readers, I hope you find some value in the magazine. Also, I would like to thanks you for being together in this beautiful journey so far. We would love to have your valuable feedback and suggestions as they help us to come up with better content each time. For any further valuable addition, please write to us at editor@microbiozindia.com.

DISCLAIMER: This disclaimer informs readers that the views, thoughts, and opinions expressed in the Articles, Advertisements published in the magazine belong solely to the author, advertisers and not necessarily to the author’s employer, organization, committee or other group or individual. The published material, adverts, editorials and all other content is published in a Microbioz India magazine cannot guarantee and accepts no liability for any loss or damage of any kind caused by this magazine and errors and for the accuracy of claims made by the advertisers.

Cover Story

The Looming Threat of Reused Insulin needles A Word of Caution for People living with diabetes ndia has witnessed an alarming rise in incidence of diabetes in the last two decades. The country represents 49 percent of the world’s diabetes burden with an estimated 72.9 million cases in 2017, a number expected to almost double to 134 million by 2025. Diabetes, one of the major non-communicable diseases in India, accounts for about half million deaths in a year.

Insulin therapy is often a crucial part of diabetes management. About 35 percent of people living with diabetes are currently on insulin. In people with type 1 diabetes insulin is the mainstay of treatment. However, people with type 2 who are not well controlled on oral drug therapy, diet and exercise may also need insulin injections to control the blood glucose levels and prevent long-term complications from the disease like cardiovascular disease, stroke, peripheral vascular disease, kidney disease etc. These risks can be significantly reduced through good glycaemic control, diet, exercise and taking insulin properly. Injection technique is crucial in achieving optimal control of diabetes in patients on insulin therapy. For optimal insulin absorption, insulin needs to be injected into the fat layer under the skin to avoid the muscle. It is also important to use a new site each time for every injection. It is also recommended not to inject into the same site repeatedly and it is recommended to change the needle with every use/injection. “In Pune, many people with diabetes still re-use their insulin syringes and pen needles due to reasons like unawareness and cost. As healthcare professionals we strive to educate patients, their families and even physicians treating them about the disadvantages of re-using and its long-term clinical implications and healthcare cost burden. At our hospital we have a dedicated team of clinicians and diabetes educators

who train patients on various aspects of injection technique right from the first visit itself. Our team spends time with the patient making them confident to independently take their injections, follow correct injection site rotation, prevent re-use and the awareness and prevention of Lipohypertrophy (a swelling that occurs at the site of insulin injection due to excess fat accumulation under the skin). Each step towards the right direction counts and we must discourage the re-use of insulin needles, looking at the bigger benefits of optimizing insulin administration for better glycemic control.”- said Dr. Unnikrishnan AG, CEO and Chief of Endocrinology at the Chellaram Diabetes Institute and FITTER India Scientific Advisory Board member, Pune. “At our centres, our team of professionals, train patients on various aspects of correct injection technique, lipohypertrophy and discourage re-use of needles. Patients are also educated on safe disposal of their needles. Through our various educational programs during our regional conferences and local type 1 educational programs, we train over 1500 clinicians and diabetes educators every year and also reach out to more than 400 number of patients each year, disseminating the importance of the FITTER recommendations on correct insulin injection

Microbioz India, November 2019

Cover Story technique” said Dr. Banshi Saboo, Chairman

and Chief Diabetologist, Diabetes Care & Hormone Clinic and FITTER India Scientific Advisory Board Member, Ahmedabad. “In Bangalore 95 % of people with diabetes do re-use needles primarily due to lack of awareness and training on the correct injection practices. It is important to understand that for the medication to be effective, it must be taken correctly and why patients must always use a new needle for every injection. Reuse of needles and incorrect injection technique can lead to serious yet avoidable consequences & complications and medication errors. At our center, our team of doctors and diabetes educators ensure proper injection technique and needle use.” Said Dr. Anantharaman. R, Endocrinologist Magna Centers for Obesity, Diabetes and Endocrinology (MAGNA CODE) Bengaluru. Insulin pen and syringe needles are intended for single use only, but it is known that a significant proportion of people with diabetes do re-use needles primarily due to lack of awareness and training on the correct injection practices. Needle re-use causes blunting and bending of the needle tip, increasing pain & bleeding, dosage inaccuracy, and Lipohypertrophy. Lipo is a thickened,

rubbery swelling under the skin at the patient’s usual injection sites. Lipohypertrophy can lead to poor glycaemic control, hypoglycaemia and glycaemic variability. Studies show that the frequency of needle reuse, significantly increases the risks of developing lipo. Bacteria is present on the needle after the injection is completed and bacterial growth increases with further re-use. Macroscopic regurgitation into the cartridges is also observed. Should any caregiver get a needle stick injury with this, it could pose a potential danger of transmission of blood borne diseases such as HIV or hepatitis. Health-care professionals should create awareness among the patients regarding the potential adverse effects of re-use and discourage this practise. Adherence to medication is a major factor in determining treatment outcomes for patients. In India, this is particularly true in the management of chronic manageable diseases such as diabetes. It is important to understand that for the medication to be effective, it must be taken correctly and why patients must always use a new needle for every injection. Reuse of needles and incorrect injection technique can lead to serious yet avoidable consequences & complications and medication errors. Hence, for patient safety, there is a dire need of spreading awareness about avoiding the reuse of insulin needles.

Microbioz India, November 2019

Research News

Little-known protein appears to play important role in obesity and metabolic disease The recently discovered protein is normally abundant in fat; without it, the body struggles to manage glucose and insulin With unexpected findings about a protein that's highly expressed in fat tissue, scientists at Scripps Research have opened the door to critical new understandings about obesity and metabolism. Their discovery, which appears Nov. 20 in the journal Nature, could lead to new approaches for addressing obesity and potentially many other diseases. The signaling protein, known as PGRMC2, had not been extensively studied in the past. Short for "progesterone receptor membrane component 2," it had been detected in the uterus, liver and several areas of the body. But the lab of Enrique Saez, PhD, saw that it was most abundant in fat tissue -particularly in brown fat, which turns food into heat to maintain body temperature -- and became interested in its function there.

An important role: heme's travel guide The team built on their recent discovery that PGRMC2 binds to and releases an essential molecule called heme. Recently in the spotlight for its role in providing flavor to the plant-based Impossible Burger, heme holds a much more significant role in the body. The iron-containing molecule travels within cells to enable crucial life processes such as cellular respiration, cell proliferation, cell death and circadian rhythms. Using biochemical techniques and advanced assays in cells, Saez and his team found that PGRMC2 is a "chaperone" of heme, encapsulating the molecule and transporting it from the cell's mitochondria, where heme is created, to the nucleus, where it helps carry out important functions. Without a protective chaperone, heme would react with -- and destroy -- everything in its path. "Heme's significance to many cellular processes has been known for a long time," says Saez, associate professor in the Department of Molecular Medicine. "But we also knew that heme is toxic to the cellular materials around it and would need some sort of shuttling pathway. Until now, there were many hypotheses, but the proteins that traffic heme had not been identified."

An innovative approach for obesity? Through studies involving mice, the scientists established PGRMC2 as the first intracellular heme chaperone to be described in mammals. However, they didn't stop there; they sought to find out what happens in the body if this protein doesn't exist to transport heme. And that's how they made their next big discovery: Without PGRMC2 present in their fat tissues, mice that were fed a high-fat diet became intolerant to glucose and insensitive to insulin -- hallmark symptoms of diabetes and other metabolic diseases. By contrast, obese-diabetic mice that were treated with a drug to activate PGRMC2 function showed a substantial improvement of symptoms associated with diabetes. "We saw the mice get better, becoming more glucose tolerant and less resistant to insulin," Saez says. "Our findings suggest that modulating PGRMC2 activity in fat tissue may be a useful pharmacological approach for reverting some of the serious health effects of obesity." The team also evaluated how the protein changes other functions of brown and white fat, says the study's lead author, Andrea Galmozzi, PhD. "The first surprise finding was that the brown fat looked white," he says. Brown fat, which is normally the highest in heme content, is often considered the "good fat." One of its key roles is to generate heat to maintain body temperature. Among mice that were unable to produce PGRMC2 in their fat tissues, temperatures dropped quickly when placed in a cold environment. "Even though their brain was sending the right signals to turn on the heat, the mice were unable to defend their body temperature," Galmozzi says.

Microbioz India, November 2019 12

Research News "Without heme, you get mitochondrial dysfunction and the cell has no means to burn energy to generate heat." Saez believes it's possible that activating the heme chaperone in other organs -- including the liver, where a large amount of heme is made -- could help mitigate the effects of other metabolic disorders such as non-alcoholic steatohepatitis (NASH), which is a major cause of liver transplantation today. "We're curious to know whether this protein performs the same role in other tissues where we see defects in heme that result in disease" Saez says.

Materials provided by Scripps Research Institute. Note: Content may be edited for style and length

Journal Reference: Andrea Galmozzi, Bernard P. Kok, Arthur S. Kim, J. Rafael Montenegro-Burke, Jae Y. Lee, Roberto Spreafico, Sarah Mosure, Verena Albert, Rigo Cintron-Colon, Cristina Godio, William R. Webb, Bruno Conti, Laura A. Solt, Douglas Kojetin, Christopher G. Parker, John J. Peluso, James K. Pru, Gary Siuzdak, Benjamin F. Cravatt, Enrique Saez. PGRMC2 is an intracellular haem chaperone critical for adipocyte function. Nature, 2019; DOI: 10.1038/s41586-019-1774-2

Story Source:

Microbioz India, November 2019 08

Research News

Link between inflammation and mental sluggishness shown in new study Scientists at the University of Birmingham in collaboration with the University of Amsterdam have uncovered a possible explanation for the mental sluggishness that often accompanies illness. An estimated 12M UK citizens have a chronic medical condition, and many of them report severe mental fatigue that they characterize as 'sluggishness' or 'brain fog'. This condition is often as debilitating as the disease itself. A team in the University's Centre for Human Brain Health investigated the link between this mental fog and inflammation -- the body's response to illness. In a study published in Neuroimage, they show that inflammation appears to have a particular negative impact on the brain's readiness to reach and maintain an alert state. Dr Ali Mazaheri and Professor Jane Raymond of the University's Centre for Human Brain Health, are the senior authors of the study. Dr Mazaheri says: "Scientists have

"Our research has identified a specific critical process within the brain that is clearly affected when inflammation is present." The study focussed specifically on an area of the brain which is responsible for visual attention. A group of 20 young male volunteers took part and received a salmonella typhoid vaccine that causes temporary inflammation but has few other side effects. They were tested for cognitive responses to simple images on a computer screen a few hours after the injection so that their ability to control attention could be measured. Brain

activity was measured while they performed the attention tests.

long suspected a link between inflammation and cognition, but it is very difficult to be clear about the cause and effect. For example, people living with a medical condition or being very overweight might complain of cognitive impairment, but it's hard to tell if that's due to the inflammation associated with these conditions or if there are other reasons."

On a different day, either before or after, they received an injection with water (a placebo) and did the same attention tests. On each test day they were unaware of which injection they had received. Their inflammation state was measured by analysing blood taken on each day. The tests used in the study assessed three separate attention processes, each involving distinct parts of the brain. These processes are: "alerting" which involves reaching and maintaining an alert state;

Microbioz India, November 2019

Research News "orienting" which involves selecting and prioritising useful sensory information; and "executive control" used to resolving what to pay attention to when available information is conflicting. The results showed that inflammation specifically affected brain activity related to staying alert, while the other attention processes appeared unaffected by inflammation. "These results show quite clearly that there's a very specific part of the brain network that's affected by inflammation," says Dr Mazaheri. "This could explain 'brain fog'." Professor Raymond says, "This research finding is major step forward in understanding the links between physical, cognitive, and mental health and tells us that even the mildest of illnesses may reduce alertness." Dr Leonie Balter the first author of the study which was completed as part of her PhD, concluded : "Getting a better understanding of the relationships between inflammation and brain function will help us investigate other ways to treat some of these conditions. For example, further research might show that patients with conditions associated with

chronic inflammation, such as obesity, kidney disease or Alzheimer's, could benefit from taking anti-inflammatory drugs to help preserve or improve cognitive function." "Furthermore, subtle changes in brain function may be used as an early marker cognitive deterioration in patients with inflammatory diseases." The next step for the team will be to test the effects of inflammation on other areas of brain function such as memory.

Story Source: Materials provided by University of Birmingham. Note: Content may be edited for style and length.

Journal Reference: Leonie JT. Balter, Jos A. Bosch, Sarah Aldred, Mark T. Drayson, Jet JCS. Veldhuijzen van Zanten, Suzanne Higgs, Jane E. Raymond, Ali Mazaheri. Selective effects of acute low-grade inflammation on human visual attention. NeuroImage, 2019; 202: 116098 DOI: 10.1016/j.neuroimage.2019.116098

Microbioz India, November 2019 08

Research News

Higher antibiotic exposure linked to increased risk of Parkinson's disease Higher exposure to commonly used oral antibiotics is linked to an increased risk of Parkinson's disease according to a recently published study by researchers form the Helsinki University Hospital, Finland. The strongest associations were found for broad spectrum antibiotics and those that act against anaerobic bacteria and fungi. The timing of antibiotic exposure also seemed to matter. The study suggests that excessive use of certain antibiotics can predispose to Parkinson's disease with a delay of up to 10 to 15 years. This connection may be explained by their disruptive effects on the gut microbial ecosystem. The link between antibiotic exposure and Parkinson's disease fits the current view that in a significant proportion of patients the pathology of Parkinson's may originate in the gut, possibly related to microbial changes, years before the onset of typical Parkinson motor symptoms such as slowness, muscle stiffness and shaking of the extremities. It was known that the bacterial composition of the intestine in Parkinson's patients is abnormal, but the cause is unclear. Our results suggest that some commonly used antibiotics, which are known to strongly influence the gut microbiota, could be a predisposing factor." Filip Scheperjans MD, PhD, research team leader, neurologist, Department of Neurology of Helsinki University Hospital

In the gut, pathological changes typical of Parkinson's disease have been observed up to 20 years before diagnosis. Constipation, irritable bowel syndrome and inflammatory bowel disease have been associated with a higher risk of developing Parkinson's disease. Exposure to antibiotics has been shown to cause changes in the gut microbiome and their use is associated with an increased risk of several diseases, such as psychiatric disorders and Crohn's disease. However, these diseases or increased susceptibility

to infection do not explain the now observed relationship between antibiotics and Parkinson's. Related Stories Accelerating Medicines Partnership program for Parkinsonâ&#x20AC;&#x2122;s disease launches new data portal Does Parkinson's disease start in the brain or gut? Does bipolar disorder increase the risk of Parkinson's disease? "The discovery may also have implications for antibiotic prescribing practices in the future. In addition to the problem of antibiotic resistance, antimicrobial prescribing should also take into account their potentially long-lasting effects on the gut microbiome and the development of certain diseases," says Scheperjans. The possible association of antibiotic exposure with Parkinson's disease was investigated in a casecontrol study using data extracted from national registries. The study compared antibiotic exposure during the years 1998-2014 in 13,976 Parkinson's disease patients and compared it with 40,697 nonaffected persons matched for the age, sex and place of residence. Antibiotic exposure was examined over three different time periods: 1-5, 5-10, and 10-15 years prior to the index date, based on oral antibiotic purchase data. Exposure was classified based on number of purchased courses. Exposure was also examined by classifying antibiotics according to their chemical structure, antimicrobial spectrum, and mechanism of action. Source: University of Helsinki Journal reference: Mertsalmi, T.H., et al. (2019) Antibiotic exposure and risk of Parkinson's disease in Finland: A nationwide caseâ&#x20AC;?control study. Movement Disorders. doi.org/10.1002/mds.27924.

Microbioz India, November 2019

Featured Article

Diabetic Retinopathy Dr. Rajesh R, Consultant Vitreo-retina & Ocular Oncology, Sankara Eye Hospital Diabetic retinopathy usually starts as a mild disease. During the initial stages, the blood vessels in the retina become weak and small bulges are developed called microaneurysms. These may burst causing tiny blood hemorrhages on the retina. Normally they do not cause symptoms affecting the vision. Diabetics don't develop diabetic retinopathy if the disease is less than 10 years however, it is better not to delay an eye test. Diabetic retinopathy is Diabetic retinopathy is a complication of diabetes that caused mainly due to high can lead to total blindness without treatment. blood sugar levels damaging the network of tiny blood may be a more serious symptom of eye problem. vessels that supply blood to the retina. People with diabetes may develop three It affects light-sensitive tissue blood vessels in the major eye problems like cataracts, glaucoma, and retina that lines the back of the eye. This happens retinopathy. Macula edema is a condition where the among the working-age adults the common cause macula swells with fluid blurring the vision. Nonof vision loss in diabetics leading to proliferative retinopathy does not require vision impairment and treatment, macular edema must be treated, blindness. Diabetic macular edema (DME)causes fortunately, treatment is effective sometimes even blurred vision which has no symptoms in the reverses the loss of vision. early stages. The disease often Diabetic retinopathy patients are progresses unnoticed until it affects vision. generally asymptomatic initially, however in Abnormal retinal blood vessels bleeding causes the advanced stages the patients experience floaters, appearance of wavy vision and color changes distortion or blurred vision. The earliest clinical â&#x20AC;&#x153;floatingâ&#x20AC;? spots are the other symptoms of macular sign of diabetic retinopathy are Micro aneurysms. edema. When blood vessels leak into the center of your eye it is Proliferative retinopathy. Blurry Four stages of Diabetic retinopathy: vision is one of the signs along with spots or Mild Nonproliferative Retinopathy - balloonfloaters, or having trouble with night vision. like swelling in small areas of the retina's tiny blood Usually, Vision returns to normal with vessels called microaneurysms occur. glucose levels streamlined. If blurriness doesn't go Moderate Nonproliferative Retinopathy. blood away when glucose levels are close to normal vessels nourishing the retina are blocked. retinopathy, could be a cause leading to blindness. Severe Nonproliferative Retinopathy. Blockage an ophthalmologist or optometrist can detect in the blood vessel increases thereby depriving vision loss and other problems by a dilated eye parts of the retina with blood supply which further exam and Visual acuity testing measures eye's signals the body a need for nourishment by growth ability to focus and to see details at near and far of new blood vessels. distances. Ophthalmoscopy and slit lamp exam. Proliferative Retinopathy. The new abnormal The lens of the eye to swell during High blood and fragile blood vessels grow along the retina that sugar will change the ability to see, blurred vision fills the inside of the eye. they do not cause

Microbioz India, November 2019

Featured Article symptoms or vision loss. However, blood vessels have thin, fragile walls which could leak blood leading to vision loss and even blindness. There is no cure for diabetic retinopathy. Laser treatment (photocoagulation) is used largely for preventing vision loss before the retina gets severely damaged. Surgically removing the vitreous gel (vitrectomy) also helps vision improvement, provided the retina is not severely damaged. It is possible to live a normal life with diabetes if sufferers eat healthily and take exercise and manage medication (if needed) well. ... Left untreated, diabetes can cause blindness, heart disease, stroke, nerve damage (sometimes leading to ulcers and even amputation of limbs), and kidney failure. Diagnosis In the early stages, diabetic retinopathy does not cause any noticeable symptoms. Therefore, it tends to be diagnosed as a result of a diabetic eye screening test. This would include a comprehensive eye exam including a slit lamp examination, a dilated retinal check, and measure of your intraocular pressure. Thereafter additional tests like

a Fundus Fluorescein Angiography (FFA), Ultrasound B-Scan or an Optical Coherence Tomography to study the structure of the eye may be done.

Treatment Laser Treatment: Lasers are widely used in treating diabetic retinopathy and is performed as an out-patient procedure. In this treatment, an intense beam of light is focused on the area to be treated with the aid of the slit lamp and a special contact lens. This will reduce the retinal thickening and stops bleeding. Additional treatment may be required depending on the patientâ&#x20AC;&#x2122;s condition. Surgical Treatment: In some patients, the vitreous may pull on the retina reducing vision severely. In such cases, a surgical procedure called vitrectomy is performed. This surgery is done for advanced stage of Diabetic Retinopathy. Intravitreal injections: This may be recommended in selected conditions. The drug injected would depend on your condition and your doctor would discuss the same with you.

Microbioz India, November 2019

Featured Article

Venturing Healthcare Business Abroad Many entrepreneurs & healthcare businesses have the ambition to ramp up services across borders. Choice of the country is the initial & most important step as a foundation to this dream & quite vital for the business & its management team. Scanning from Nigeria to Nepal, each country has its own distinct makeup of social, demographic, economic, financial, regulatory & political environment, has its variant culture, resources and global outlook. A due diligence should consist evaluation on size of the market, opportunity available, supply chain existence, technology scanning, growth rate, competitive environment, local infrastructure & relevant human resources available Setting up of the business also requires understanding of commonly used business entities available locally, dollar availability & currency valuation, repatriation of profits mechanism, finance & audit requirements, taxation, bilateral trade agreements and healthcare compliances. Anyone stepping into a foreign business environment must take care of the laws, rules and healthcare regulations of the host country & all must adhere to all compliances for making hasslefree & impactful entry. The various entry strategy routes available can be M & A fuelled expansion, export of services, licencing your brand, managing a department of a local hospital, franchising, joint venture with local entities, 100% ownership projects etc.

The Marketing Environment Healthcare companies essentially need to keep the patient at the centre & enfold all services around their needs. This might require new modelling of marketing mix and technology to develop the service offering of the company The external marketing environment components like social, demographic, political, legal etc, needs considered carefully by the new entrant. With respect to healthcare, another important variable is the payer system (insurers) analysis as this has profound impact of the way the business operates in the country In a foreign land, the healthcare marketing manager can better attempt to create effective marketing mix rather than influencing environmental variables. It might be easier to manage usual marketing mix of 4Ps (Product, Place, Price, Promotion) or 7 Ps (as in services marketing) rather than persuading

Raj Sehgal with the uncontrollable variables or the external environment. Some of the external marketing environment factors that need attention include:  Social factors which include but not limited to, the cultural values & lifestyle;  Demographic factors, important as this is study of people’s statistics,  Economic factors include study of disposable income, purchasing power etc  Political & legal factors  Competitive environment Following few pointers maybe considered while drafting the new country marketing mix, keeping above factors in mind:  Offering good systems around patient care & clinical outcomes.  Concept of prevention & wellness are general enablers for any healthcare receptive market.  Community interactions through OPD camps can be collaborative to society This must include means for information sharing & educating public  Demographical studies can help to offer better solutions, knowing that a geriatric population exits, may help you to innovate packages around it.  Understanding the purchasing power & inflation trends of the country, may help the company to device pricing strategy for the country  Innovations must be key component of the strategy, the company might have to look healthcare delivery beyond healthcare institutions  Capacity development through training local talent is important in multiple aspects 

Microbioz India, November 2019

Featured Article

Young children and adults above 65 years of age are most prone to pneumonia Dr. Suruchi, Consultant - Paediatrics and Paediatric Endocrinology, Columbia Asia Hospital Whitefield Pneumonia is referred to as the infection that inflames the air sacs (alveoli) in either one or both the lungs. Fluid or pus may get filled in the alveoli, leading to difficulty in breathing and can also cause cough with phlegm or pus, fever, etc. Pneumonia can be mild and even life-threatening. Infants and young children, people older than age 65, and people with health problems or weakened immune systems are most prone to serious pneumonia. Symptoms of

 

Fatigue or tiredness Loss of appetite

Some symptoms that vary according to the age are:  Children under the age of 5 years may experience fast breathing or wheezing.  Infants generally do not show very noticeable symptoms, but may vomit sometimes, lack of energy, or have trouble drinking or eating. 

Older people also usually have milder symptoms. They are likely to show confusion, changes in mental health or a lower than

normal body pneumonia include:  Coughing that can generate phlegm (mucus)  Fever  Chills or sweating  Shortness of breath usually during normal activities or at times even while resting  Chest pain that worsens while breathing or coughing

temperature. If consistent difficulty in breathing is observed accompanied by chest pain or persistent fever usually of 102 F (39 C) or higher, or persistent cough, especially with pus, it is advised to get yourself examined said Dr. Suruchi, Consultant Pediatrics and Pediatric Endocrinology, Columbia Asia Hospital Whitefield. It's more important for people in these highrisk groups to visit a doctor:

Microbioz India, November 2019

Featured Article Elderly people over 65 years of age Children below the age of 2 years with the abovementioned signs and symptoms People with an underlying health condition or those with a weak immune system People undergoing chemotherapy or taking medication that suppresses the immune system For some older adults and people with chronic lung problems or heart failure There are many types of infectious agents that can cause pneumonia. A variety of organisms, including bacteria, virus, and fungi can be held responsible. The germs that lead to pneumonia are contagious as well which means they can spread from person to person. Airborne droplets from a sneeze or cough if inhaled can also spread viral or bacterial pneumonia. Coming in contact with surfaces or objects that are contaminated with pneumonia-causing bacteria or viruses can also cause infection. Fungi from soil or bird droppings can also lead to pneumonia, especially in people with weakened immune systems. Some of the risk factors for pneumonia include: Being hospitalized often leaves the patient exposed to the risk of pneumonia, especially if the patient is on a breathing-related machine like a ventilator. If a person already has asthma, chronic obstructive pulmonary disease (COPD) or heart disease. If a person is a regular smoker, his/her body’s natural defenses against the bacteria and viruses that because pneumonia are damaged. People with HIV/AIDS, who've had an organ transplant, or who receive chemotherapy or longterm steroids are at risk.

groups may experience complications, including: Bacteria that enter the bloodstream (bacteremia) from the lungs can spread the infection to other organs, and tend to cause organ failure. If the pneumonia is severe or the person has chronic underlying lung diseases, one can have trouble breathing in the enough amount of oxygen. Pneumonia can also cause fluid to build up in the thin space between layers of tissue that line the lungs and chest cavity (pleura). For prevention of pneumonia: Get proper vaccination that is available to prevent certain types of pneumonia and the flu. Take these in proper consultation with your doctor.  Ensure good hygiene.  Avoid smoking.  Strengthen the immune system.  Take enough sleep, exercise regularly and eat a healthy diet. Pneumonia in kids During childhood, pneumonia becomes a rather common condition. The causes of childhood pneumonia can however vary. Pneumonia can be dangerous especially in young children. For children under 5 years of age, pneumonia due to respiratory viruses, Streptococcus pneumonia, and Haemophilus influenza. For children between the ages of 5 and 13, pneumonia due to Mycoplasma pneumonia is frequently observed in children. If the following signs are noticed in the child, do consult the pediatrician:  Trouble breathing  Lack of energy  Changes in appetite  High- grade fever

Even with treatment, some people with pneumonia, especially those in high-risk

Microbioz India, November 2019

Featured Article

New Test for Thyroid Cancer Could Prevent Unnecessary Surgery Researchers at the University of Texas at Austin and Baylor College of Medicine have developed a new preoperative test for thyroid cancer that is faster and about two-thirds more accurate than the diagnostics physicians use today. Although more validation will be necessary before it can be used clinically, the new metabolic thyroid test shows promise for preventing thousands of unnecessary thyroid removals each year. “If we could prevent people from having surgery they don’t need and enable them to have a more precise diagnosis, we can improve treatment for patients and lower costs for the healthcare system,” says Livia S. Eberlin, PhD, assistant professor of chemistry and diagnostic medicine at the University of Texas at Austin and coprincipal investigator. Rachel DeHoog, a graduate student who worked on the study, adds, “Also very importantly, the ability to have certainty in your diagnosis is transformative for a patient presented with the grueling possibility of having cancer.”

cancer, the patient may receive a follow-up genetic test that can itself produce false-positive results. Given such diagnostic uncertainties, doctors often recommend removing all or part of the thyroid— the gland in the neck that produces hormones that control the body’s metabolic rate as well as heart and digestive functions, muscle control, brain development, mood, and bone maintenance. Thousands of patients have the surgery each year, only to learn later that it was unnecessary.

A microphotograph of thyroid cancer cells, specifically papillary thyroid carcinoma. Photo courtesy Wendong Yu, MD, PhD, Baylor College of Medicine.

Livia S. Eberlin, PhD, University of Texas at Austin. Photo courtesy of the Moore Foundation.

About 52,000 new cases of thyroid cancer are diagnosed each year in the United States.2 Unfortunately, the test used for diagnosis, called fine-needle aspiration (FNA), is inconclusive about one out of every five times. When a pathologist is unable to confirm the presence of

Using a technology called mass spectrometry imaging, the new metabolic thyroid test identifies metabolites produced by cancerous cells that act as a kind of diagnostic fingerprint. The researchers worked on identifying such diagnostic metabolic fingerprints for more than 2 years, using tissue specimens from 178 patients, before starting a pilot clinical study. During the clinical study, 68 new patients were tested, nearly a third of whom had received inconclusive FNA results. The new

Microbioz India, November 2019

Featured Article metabolic thyroid test returned a false positive only about one time in 10, and could have prevented 17 of the study patients from undergoing unnecessary surgeries. The improved accuracy of the new test may prevent unnecessary surgeries, many of which lead patients to need hormone replacement therapy for the rest of their lives or to have to cope with other consequences of having all or part of their thyroid removed. Amanda Helms, a graduate student in chemistry at the University of Texas at Austin, learned a few years ago that lumps on her thyroid were indicative of possible cancer. When her FNA biopsy came back as inconclusive, a doctor recommended removing the right half of her thyroid. A difficult surgery and recovery followed, though Helms soon received word that pathologists detected no cancer in the removed tissue. “All the uncertainty was nerve wracking,” says Helms, who adds that the new test could prevent others from going through what she did.

recovery,” Helms says. “It would also take away the uncertainty.” James Suliburk, MD, a coprincipal investigator and head of endocrine surgery at Baylor College of Medicine, collected FNA biopsies from patients involved in the study and implemented the technology in a pilot trial to demonstrate the accuracy of the new test. “With this next-generation test, we can provide thyroid cancer diagnoses faster and with more precision than current techniques,” says Suliburk. “This will be the new state of the art. We are able to do this analysis directly on the FNA sample and much more rapidly than the current process, which could take between 3 and 30 days.” The team is now preparing to start a 2-year validation study, using FNAs from about a thousand new patients in Australia, Brazil, and the United States. If the results hold up, the researchers hope the technology will become a routine diagnostic tool. For further information, visit the University of Texas at Austin.

References

The thyroid is a gland in the neck that produces hormones that control the body’s metabolic rate, as well as heart and digestive function, muscle control, brain development, mood, and bone maintenance. Illustration by Melanie Connolly courtesy University of Texas at Austin.

“A lot fewer people would have to get surgery unnecessarily, which saves them time, money, and

DeHoog RJ, Zhang J, Alore E, et al. Preoperative metabolic classification of thyroid nodules using mass spectrometry imaging of fine-needle aspiration biopsies. Proc Natl Acad Sci USA.2019;116(43):21401–21408. Key statistics for thyroid cancer [online]. Atlanta: American Cancer Society, 2019. Available at: www.cancer.org/cancer/thyroidcancer/about/key-statistics.html. Accessed November 20, 2019. Featured image: A new preoperative test for thyroid cancer that’s faster and more accurate than the diagnostics that doctors use today could prevent thousands of unnecessary thyroid removals each year. Photo courtesy iStock.

Microbioz India, November 2019

Product Launches

Syngene Sponsors Tufts Launchpad | BioLabs to Support Biomedical Innovation in Boston

Dr Christine Kressirer, an employee of Biolabs and Site Director at Tufts Launchpad | BioLabs, explained: “We’re always looking for best-in-class suppliers to partner with, so we’re delighted that Syngene has agreed to become one of our new sponsors. Their backing will ensure scientists locating their companies here will have capital efficient access to the best equipment to help them generate the data they need to rapidly grow their business.” Maureen Gauvreau, Manager at Syngene USA added: “Tufts Launchpad | BioLabs is attracting some excellent up and coming biotechs and we look forward to supporting their scientists with tools and techniques to advance their vital research.” Story source/credit: Syngene

Noninvasive Preimplantation Genetic Testing Kit Offers Alternative to IVF Embryo Biopsies Syngene, a world-leading manufacturer of image analysis solutions, is pleased to announce it has entered a sponsorship agreement with Tufts Launchpad | BioLabs developed by Tufts University to be Boston’s premier fully equipped, co-working and shared lab space for biotech startups. Under the terms of the sponsorship, scientists working in biotech and life science companies located at Tufts Launchpad | BioLabs will have access to a G:BOX mini multi-application imaging system, as well as support from Syngene’s highly experienced technical team. The system, Syngene’s most advanced, combines a unique motor driven stage and cooled high resolution camera and is being successfully used by prestigious biopharma companies and academic institutes world-wide to analyze genes and proteins associated with life threatening diseases. Having Syngene’s equipment and expertise available at Tufts Launchpad | BioLabs will enable scientists working there to utilize versatile, highly precise optical imaging technology and will guarantee they produce real images of gels and blots for important applications such as identifying novel therapeutic targets.

PerkinElmer, Waltham, Mass, has introduced its PG-Seq rapid noninvasive preimplantation genetic testing for aneuploidy (PGT-A) kit. The product tests spent embryo culture media for chromosomal abnormalities during in vitro fertilization (IVF) treatment. PGT-A is used to identify viable embryos, in order to avoid the transfer or storage of embryos with an incorrect number of chromosomes, because those embryos typically lead to failed IVF cycles. Traditionally, PGT-A requires a biopsy of a developing embryo, which is done by creating an opening in the outer coating in order to remove and test a few cells. However, recent studies have shown that an embryo releases small amounts of

Microbioz India, November 2019

Product Launches iDNA

into the culture media in which it is growing, which means that genetic testing can instead be done on the surrounding fluid.1 PerkinElmer’s PG-Seq rapid noninvasive PGT-A kit is specifically designed for this type of sample, which enables embryos to remain fully intact. The new noninvasive kit tests the spent embryo culture media to detect aneuploidies as well as structural rearrangements, including unbalanced translocations and segmental errors.

Masoud Toloue, PhD, PerkinElmer. “Data from a global network of 15 laboratories who have provided samples shows it is possible to achieve more than 90% correlation between results of biopsied embryo and spent embryo culture media with the PG-Seq rapid noninvasive PGT-A kit,” says Masoud Toloue, PhD, vice president for diagnostics at PerkinElmer. “By eliminating the risks associated with performing a cell biopsy, PGT-A becomes more broadly accessible. IVF providers can significantly increase the likelihood of successful embryo transfers and reduce time to pregnancy.” Reference Lane M, Zander-Fox DL, Hamilton H, et al. Ability to detect aneuploidy from cell-free DNA collected from media is dependent on the stage of development of the embryo. Fertil Steril. 2017;108(3 suppl):e61; doi: 10.1016/j.fertnstert.2017.07.192. Story source/credit: Perkin Elmer

High-Efficiency Laminar-Flow Hoods

Purair laminar-flow hoods from Air Science, Fort Myers, Fla, are high-efficiency products designed to protect equipment and other contents of the work zone from particulates. The product line includes vertical laminar-flow hoods and horizontal laminar-flow hoods suitable for use with nonhazardous contaminants and when flexible access to the equipment in the work zone is desired. All hoods in the series make use of the Air Science multiplex ultralow particulate air (ULPA) filtration technology to create a clean work environment over a wide range of applications. The hoods feature a high-capacity air-handling system that delivers a flow velocity of 80 to 100 fpm, and an ULPA filter pressure gauge that measures filter performance.All models use ULPA filters, which are 99.999% efficient at removing particle sizes between 0.1 and 0.3 µm. Air cleanliness exceeds ISO Class 4 requirements, providing a sterile work environment for aseptic techniques. The back walls of the vertical-flow hoods are perforated to reduce work-surface turbulence by removing some of the airflow to the rear. All models are equipped with a stainless-steel work surface. They are available in six widths from 24 inches to 96 inches. Story source/credit: Air Science.

Microbioz India, November 2019

Product Launches

ExomeCG Simplifies Generation and Interpretation of Molecular and Cytogenomic Data

platform allows fast and accurate interpretation of next-generation sequencing data. “The launch of ExomeCG enables us to deliver a comprehensive clinical bioinformatics service to our customers and advance clinical cytogenomics by providing a robust, cost-effective, and userfriendly laboratory and analysis workflow,” says Sale. “ExomeCG now offers a validated single-test solution, enabling customers to obtain the highest diagnostic yield while removing additional workflows and the associated time and costs.” Story source/credit: Nonacus.

Microscopy System Integrates Widefield and Confocal Imaging Capabilities Nonacus, Birmingham, UK, has launched ExomeCG, a clinically enhanced exome capture kit to simplify the generation and interpretation of molecular and cytogenomic data. ExomeCG enables the genomics community to perform and targeted copy number analysis in a single assay. The clinically validated test replaces the need for chromosomal microarray and multiplex ligation-dependent probe amplification tests, saving time and costs while achieving high diagnostic yields.

Chris Sale, Nonacus. “The current cytogenomics paradigm typically requires a multitest strategy whereby chromosomal microarrays are first run achieving a modest 15% diagnostic yield,” says Chris Sale, CEO of Nonacus. “Subsequently, exome sequencing is undertaken in order to raise the diagnostic yield to around 40%.” ExomeCG was codeveloped with Congenica, Cambridge, UK, which specializes in software solutions that enable accelerated interpretation of complex genomic data to improve disease diagnosis. The Congenica clinical decision support

The Zeiss Celldiscoverer 7 is a fully integrated highend imaging system featuring a variety of incubation and detection options. The system can be combined with the Zeiss LSM 900 with Airyscan 2, enabling users to perform superresolution 3-D imaging with up to 1.5x higher resolution. Additionally, researchers can easily separate multiple labels with spectral imaging. Celldiscoverer 7 simplifies laboratory setup. All components are designed to offer hassle-free automated imaging, so that users can expect better data in shorter times, with less training and maintenance. The system’s capabilities can be expanded with confocal technology, external cameras, deconvolution, and additional environmental controls needed for the observation of live cells. Story source/credit: Zeiss.

Microbioz India, November 2019

Product Launches

New Diagnostic Test for High-Risk Strains of HPV

The HPV assay developed by Self-Screen is a realtime polymerase chain reaction-based test that detects 15 recognized high-risk genotypes of human papillomavirus DNA. Under the companies’ partnering agreement, Self-Screen will handle regulatory processes to obtain CE marking for the assay on the NeuMoDx systems, while NeuMoDx will manufacture and sell the assay. Qiagen is the exclusive distributor of the NeuMoDx 288 and NeuMoDx 96 molecular systems in Europe and other major markets outside the United States, while NeuMoDx covers the United States directly. Under a 2018 agreement, Qiagen has the right to acquire the remaining 80% of NeuMoDx shares that it does not currently own until mid 2020. HPV is the most common viral infection of the genital tract and the major cause of cervical cancer, the fourth most common cancer among women. The World Health Organization reported an estimated 570,000 new cases of cervical cancer and 311,000 deaths in 2018. Almost 300 million women globally are estimated to be infected with HPV, and about 30 million additional cases have progressed to the precancerous stage. For more information visit NeuMoDx.

NeuMoDx Molecular, Ann Arbor, Mich, in conjunction with Self-Screen BV, Amsterdam, the Netherlands, has introduced a CE-marked molecular diagnostic for high-risk strains of human papillomavirus (HPV) on the NeuMoDx 288 and NeuMoDx 96 molecular systems. HPV is the virus regarded as the major cause of cervical cancer.

Ambry Genetics Launches Paired RNA and DNA Testing for Hereditary Cancer

Jeff Williams, NeuMoDx “Self-Screen is a leader in developing innovative molecular tests for the diagnosis of genital cancers, and adding this important women’s health assay to our fully automated continuous random-access NeuMoDx systems will help in the global battle to prevent cervical cancer,” says Jeff Williams, chairman and CEO of NeuMoDx. “This agreement represents the next step in our strategy to expand our systems’ content menu by collaborating with key assay partners.”

Ambry Genetics, Aliso Viejo, Calif, has launched +RNAinsight, a major advance in genetic testing that enables clinicians to conduct both DNA and RNA genetic testing at the same time.

Microbioz India, November 2019

Product Launches DNA testing alone can produce inconclusive, unhelpful results about whether a genetic variant increases the risk for cancer. Moreover, standard DNA testing for hereditary cancer excludes large portions of DNA, thereby missing variants that cause increased risks for cancer. Testing RNA as well as DNA overcomes such limitations for a significant number of patients because RNA provides considerably more evidence than DNA alone about whether a person carries variants that cause increased risks for cancer. Testing both RNA and DNA simultaneously represents the first genetic testing advance in more than a decade to significantly increase the diagnostic yield (meaning the number of patients identified with a specific hereditary risk for cancer) in genes such as BRCA1 and BRCA2. Clinicians can use this information with patients and their relatives to try to prevent cancer from developing or to detect cancer early.

Aaron Elliott, PhD, Ambry Genetics. “We developed paired RNA and DNA testing to provide more accurate and conclusive results that patients and doctors can act on,” says Aaron Elliott, PhD, CEO of Ambry Genetics. “With +RNAinsight, we not only identify mutations that DNA testing alone would miss, we also provide answers for patients who have been dealing with inconclusive results for years.” This year, almost 700,000 people in the United States are expected to undergo clinical-grade genetic testing to learn whether they have genetic mutations linked to increased risks of cancer. With paired RNA and DNA testing, an estimated 16,000 of these individuals could get the genetic information they need that they might not get from DNA testing alone. “Paired RNA and DNA genetic testing is a remarkable leap forward. My patients are finally getting answers I was unable to provide before,“ says Huma Rana, MD, clinical director of cancer genetics and prevention at Dana Farber Cancer Institute. “In our short time using this technology, we have made meaningful changes to patient care.“ In fact, those 16,000 individuals are just the beginning of the number of people who could be helped because this number does not include their

relatives, who can then be tested to learn of their own increased risks. Nor does it include patients previously tested who had received inconclusive results from DNA testing alone and will now receive reclassification reports based on +RNAinsight. “Paired RNA and DNA testing has meant everything to me and my family in our fight against cancer, finally letting my brother, sister, and me know we have a genetic mutation that causes Lynch syndrome, which puts us at an increased risk for colorectal and uterine cancers,“ says Turkeesa Looper. “Past DNA tests never told us that, and now our family, including my nieces and nephews, can also take action.“

Huma Rana, MD, Dana Farber Cancer Institute. A prospective analysis of the first 2,500 patients tested with paired RNA and DNA hereditary cancer testing for up to 18 genes, sent in from pilot clinical sites, resulted in a relative increase in diagnostic yield of approximately 7%. The impact on diagnostic yield varies by gene, with some genes having a relative diagnostic yield increase of more than 15%. ATM, BRCA1, MSH2, and PMS2, are among the genes with higher increases. Patients with such genetic mutations will now benefit from preventive steps, early detection, reduced cancer incidence, and increased survival, as will their relatives who get tested. The data also illustrate +RNAinsight’s ability to clarify results that were previously deemed inconclusive as a result of DNA testing alone. The test was able to decrease the number of inconclusive results across the included cancer risk genes by approximately 5% relative to DNA testing alone. Ambry’s +RNAinsight is now available through doctors and genetic counselors throughout the country. For further information, visit Ambry Genetics.

Microbioz India, November 2019

Product Launches

Automated Microscope for Gentle and Fast Confocal 3-D Imaging To image samples with the best possible resolution, the LSM 900 with Airyscan 2 can be added to the Zeiss Celldiscoverer 7. The Zeiss LSM 9 family with Airyscan 2 offers superb confocal image quality, and the systemsâ&#x20AC;&#x2122; new multiplex mode enables users to perform superresolution 3-D imaging with up to 1.5x higher resolution. Researchers can also easily separate multiple labels with spectral imaging.

Celldiscoverer 7 is a fully integrated high-end imaging system designed to simplify laboratory setup and make work more comfortable. All components are optimized for hassle-free automated imaging. Users can expect better data in shorter times, with less training and maintenance. As usersâ&#x20AC;&#x2122; requirements grow, labs can expand the Zeiss Celldi scoverer 7 with confocal technology, external cameras, deconvolution, and additional environmental controls. For further information, visit Zeiss. Featured image: The Zeiss Celldiscoverer 7 is a fully integrated high-end imaging system that can now get better data from 3-D samples when coupled with the Zeiss LSM 900 with Airyscan 2 for confocal imaging.

Microbioz India, November 2019